Associations of Neighborhood Opportunity and Social Vulnerability With Trajectories of Childhood Body Mass Index and Obesity Among US Children
Authors: Izzuddin M. Aris, Wei Perng, Dana Dabelea, Amy M. Padula, Akram Alshawabkeh, Carmen M. Vélez-Vega, Judy L. Aschner, Carlos A. Camargo, Tamara J. Sussman, Anne L. Dunlop, Amy J. Elliott, Assiamira Ferrara, Yeyi Zhu, Christine L. M. Joseph, Anne Marie Singh, Tina Hartert, Ferdinand Cacho, Margaret R. Karagas, Tiffany North-Reid, Barry M. Lester, Nichole R. Kelly, Jody M. Ganiban, Su H. Chu, Thomas G. O’Connor, Rebecca C. Fry, Gwendolyn Norman, Leonardo Trasande, Bibiana Restrepo, Peter James, Emily Oken, Samia Baluch, Timothy Shields, Stephanie Merhar, Clement Ren, Gloria Pryhuber, Paul Moore, Rajan Wadhawan, Carol Wagner, John R Keller, Amy Reynolds, Roberta Keller, Mark Hudak, Adam Duncan, Ronald Walshburn, Susan L Teitelbaum, Annemarie Stroustrup, Andrea Lampland, Dennis Mayock, Jonathan Mansbach, Jonathan Spergel, Michelle Stevenson, Cindy Bauer, James Gern, Christine Seroogy, Casper Bendixsen, Irva Hertz-Picciotto, Catherine Karr, Alex Mason, Scott Weiss, George O’Connor, Robert Zeiger, Leonard Bacharier, Brian Carter, Carmen Marsit, Steven Pastyrnak, Charles Neal, Lynne Smith, Jennifer Helderman, Robert Tepper, Craig Newschaffer, Heather Volk, Rebecca Schmidt, Jean Kerver, Charles Barone, Patricia McKane, Nigel Paneth, Michael Elliott, Susan Schantz, Christina Porucznik, Robert Silver, Elisabeth Conradt, Michelle Bosquet-Enlow, Kathi Huddleston, Nicki Bush, Ruby Nguyen, Emily Barrett, Alison Hipwell, Kate Keenan, Christiane Duarte, Glorisa Canino, Stephen Dager, Robert Schultz, Joseph Piven, Hyagriv Simhan, Frank Gilliland, Shoreh Farzan, Tracy Bastain
Journal: JAMA Network Open (2022)

Importance Physical and social neighborhood attributes may have implications for children’s growth and development patterns. The extent to which these attributes are associated with body mass index (BMI) trajectories and obesity risk from childhood to adolescence remains understudied. Objective To examine associations of neighborhood-level measures of opportunity and social vulnerability with trajectories of BMI and obesity risk from birth to adolescence. Design, Setting, and Participants This cohort study used data from 54 cohorts (20 677 children) participating in the Environmental Influences on Child Health Outcomes (ECHO) program from January 1, 1995, to January 1, 2022. Participant inclusion required at least 1 geocoded residential address and anthropometric measure (taken at the same time or after the address date) from birth through adolescence. Data were analyzed from February 1 to June 30, 2022. Exposures Census tract–level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) linked to geocoded residential addresses at birth and in infancy (age range, 0.5-1.5 years), early childhood (age range, 2.0-4.8 years), and mid-childhood (age range, 5.0-9.8 years). Main Outcomes and Measures BMI (calculated as weight in kilograms divided by length [if aged &amp;amp;lt;2 years] or height in meters squared) and obesity (age- and sex-specific BMI ≥95th percentile). Based on nationwide distributions of the COI and SVI, Census tract rankings were grouped into 5 categories: very low (&amp;amp;lt;20th percentile), low (20th percentile to &amp;amp;lt;40th percentile), moderate (40th percentile to &amp;amp;lt;60th percentile), high (60th percentile to &amp;amp;lt;80th percentile), or very high (≥80th percentile) opportunity (COI) or vulnerability (SVI). Results Among 20 677 children, 10 747 (52.0%) were male; 12 463 of 20 105 (62.0%) were White, and 16 036 of 20 333 (78.9%) were non-Hispanic. (Some data for race and ethnicity were missing.) Overall, 29.9% of children in the ECHO program resided in areas with the most advantageous characteristics. For example, at birth, 26.7% of children lived in areas with very high COI, and 25.3% lived in areas with very low SVI; in mid-childhood, 30.6% lived in areas with very high COI and 28.4% lived in areas with very low SVI. Linear mixed-effects models revealed that at every life stage, children who resided in areas with higher COI (vs very low COI) had lower mean BMI trajectories and lower risk of obesity from childhood to adolescence, independent of family sociodemographic and prenatal characteristics. For example, among children with obesity at age 10 years, the risk ratio was 0.21 (95% CI, 0.12-0.34) for very high COI at birth, 0.31 (95% CI, 0.20-0.51) for high COI at birth, 0.46 (95% CI, 0.28-0.74) for moderate COI at birth, and 0.53 (95% CI, 0.32-0.86) for low COI at birth. Similar patterns of findings were observed for children who resided in areas with lower SVI (vs very high SVI). For example, among children with obesity at age 10 years, the risk ratio was 0.17 (95% CI, 0.10-0.30) for very low SVI at birth, 0.20 (95% CI, 0.11-0.35) for low SVI at birth, 0.42 (95% CI, 0.24-0.75) for moderate SVI at birth, and 0.43 (95% CI, 0.24-0.76) for high SVI at birth. For both indices, effect estimates for mean BMI difference and obesity risk were larger at an older age of outcome measurement. In addition, exposure to COI or SVI at birth was associated with the most substantial difference in subsequent mean BMI and risk of obesity compared with exposure at later life stages. Conclusions and Relevance In this cohort study, residing in higher-opportunity and lower-vulnerability neighborhoods in early life, especially at birth, was associated with a lower mean BMI trajectory and a lower risk of obesity from childhood to adolescence. Future research should clarify whether initiatives or policies that alter specific components of neighborhood environment would be beneficial in preventing excess weight in children.